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The PRINCOVID Retrospective Study: A Predictive Model of Pressure Injuries for Critical COVID-19 Patients
Ana Teixeira-Vaz1, José Afonso Rocha, Mafalda Oliveira
1From the Physical Medicine and Rehabilitation department, Centro Hospitalar Universitário de São João, Porto, Portugal (AT-V, JAR, MO, DAR, TSM, AIS); Intensive Care department, Centro Hospitalar Universitário de São João, Porto, Portugal (JAP); and Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal (JAP).
Objective:
The aim of the study is to characterize pressure injuries, identify risk factors, and develop a predictive model for pressure injuries at intensive care unit admission for critical COVID-19 patients.
Design:
This study was a retrospective analysis of a consecutive sample of patients admitted to intensive care unit between May 2020 and September 2021. Inclusion criteria encompassed the diagnosis of acute respiratory distress syndrome due to SARS-CoV-2, requiring invasive mechanical ventilation more than 48 hrs. The following predictors were evaluated: sociodemographic characteristics, comorbidities, as well as clinical and laboratory findings at intensive care unit admission. The primary outcome was the presence of pressure injuries.
Results:
Two hundred five patients were included, mostly males (73%) with a mean age of 62 yrs. Pressure injury prevalence was 58%. On multivariable analysis, male sex, hypertension, hemoglobin, and albumin at intensive care unit admission were independently associated with pressure injuries, constituting the PRINCOVID model. The model reached an area under the receiver operating characteristic curve of 0.71, surpassing the Braden scale ( P = 0.0015). The PRINCOVID score ranges from 0 to 15, with two risk groups: "at risk"(≤7 points) and "high risk"(>7 points).
Conclusions:
This study proposes PRINCOVID as a multivariable model for developing pressure injuries in critical COVID-19 patients. Based on four parameters (sex, hypertension, hemoglobin, and albumin at intensive care unit admission), this model fairly predicts the development of pressure injuries. The PRINCOVID score allows patients' classification into two groups, facilitating early identification of high-risk patients.
